Treating high blood pressure will help prevent problems such as heart disease, stroke, loss of eyesight, chronic kidney disease, and other blood vessel diseases.
You may need to take medicines to lower your blood pressure if lifestyle changes are not enough to bring your blood pressure to the target level.
WHEN ARE MEDICINES FOR HIGH BLOOD PRESSURE USED
Most of the time, your health care provider will try lifestyle changes first and check your BP two or more times.
If your blood pressure is between 120/80 and 130/80 mm Hg, you have elevated blood pressure.
- Your provider will recommend lifestyle changes to bring your blood pressure down to a normal range.
- Medicines are rarely used at this stage.
If your blood pressure is higher than 130/80 but lower than 140/90 mm Hg, you have Stage 1 high blood pressure. When thinking about the best treatment, you and your provider must consider:
- If you have no other diseases or risk factors, your provider may recommend lifestyle changes and repeat the measurements after a few months.
- If your blood pressure remains above 130/80 but lower than 140/90 mm Hg, your provider may recommend medicines to treat high blood pressure.
- If you have other diseases or risk factors, your provider may be more likely to start medicines at the same time as lifestyle changes.
If your blood pressure is higher than 140/90 mm Hg, you have Stage 2 high blood pressure. Your provider will most likely start you on medicines and recommend lifestyle changes.
Before making a final diagnosis of either elevated blood pressure or high blood pressure, your provider should ask you to have your blood pressure measured at home, at your pharmacy, or somewhere else besides their office or a hospital.
If you have a higher risk for heart disease, diabetes, heart problems, or a history of a stroke, medicines may be started at lower blood pressure reading. The most commonly used blood pressure targets for people with these medical problems are below 130/80.
MEDICINES FOR HIGH BLOOD PRESSURE
Most of the time, only a single drug will be used at first. Two drugs may be started if you have stage 2 high blood pressure.
Several types of medicine are used to treat high blood pressure. Your provider will decide which type of medicine is right for you. You may need to take more than one type.
Each type of blood pressure medicine listed below comes in different brand and generic names.
One or more of these blood pressure medicines are often used to treat high blood pressure:
- Diuretics are also called water pills. They help your kidneys remove some salt (sodium) from your body. As a result, your blood vessels do not have to hold as much fluid and your blood pressure goes down.
- Beta-blockers make the heart beat at a slower rate and with less force.
- Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) relax your blood vessels, which lowers your blood pressure.
- Angiotensin II receptor blockers (also called ARBs) work in about the same way as angiotensin-converting enzyme inhibitors.
- Calcium channel blockers relax blood vessels by stopping calcium from entering cells.
Blood pressure medicines that are not used as often include:
- Alpha-blockers help relax your blood vessels, which lowers your blood pressure.
- Centrally acting drugs signal your brain and nervous system to relax your blood vessels.
- Vasodilators signal the muscles in the walls of blood vessels to relax.
- Renin inhibitors, a newer type of medicine for treating high blood pressure, act by reducing the amount of angiotensin precursors thereby relaxing your blood vessels.
SIDE EFFECTS OF BLOOD PRESSURE MEDICINES
Most blood pressure medicines are easy to take, but all medicines have side effects. Most of these are mild and may go away over time.
Some common side effects of high blood pressure medicines include:
- Diarrhea or constipation
- Dizziness or lightheadedness
- Erection problems
- Feeling nervous
- Feeling tired, weak, drowsy, or a lack of energy
- Nausea or vomiting
- Skin rash
- Weight loss or gain without trying
Tell your provider as soon as possible if you have side effects or the side effects are causing you problems. Most of the time, making changes to the dose of medicine or when you take it can help reduce side effects.
Never change the dose or stop taking a medicine on your own. Always talk to your provider first.
Taking more than one medicine may change how your body absorbs or uses a drug. Vitamins or supplements, different foods, or alcohol may also change how a drug acts in your body.
Always ask your provider whether you need to avoid any foods, drinks, vitamins or supplements, or any other medicines while you are taking blood pressure medicine.
Hypertension - medicines
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. PMID: 24352797 www.ncbi.nlm.nih.gov/pubmed/24352797.
Victor RG. Arterial hypertension. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 67.
Victor RG, Libby P. Systemic hypertension: management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine11th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 46.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248. PMID: 29146535 www.ncbi.nlm.nih.gov/pubmed/29146535.
Review Date 5/21/2017
Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 06-11-18.